LAST week, King Edward VII Memorial Hospital (KEMH) announced it had implemented a screening process recognised by many as the most significant development in cervical cancer detection since the Papanicolaou (Pap) smear test was introduced in the 1940s.

Known as the ThinPrep Pap Test, the process was already available to women in Bermuda; its introduction to KEMH means that every step can now be completed locally.

OR females, one of the most commonly diagnosed forms of cancer is cervical cancer, with some 450,000 cases reported around the world each year. If detected early, however, cervical cancer is also one of the most curable forms of the disease.

Since the Pap test was introduced in the 1940s, it has reduced deaths from cervical cancer among American women by around 70 per cent. By all accounts, the ThinPrep Test should improve that rate, although the smear experience will be fundamentally the same.

"King Edward VII Memorial Hospital is committed to providing our users and patients with the latest technology that detects disease in its early stages," said Dr. Kered James, the hospital's director of pathology.

"After a thorough evaluation, it was clear that the ThinPrep Pap Test offered significant improvements over the 50-year-old conventional Pap smear. Making this proven technology available to our users was simply the right thing to do."

The ThinPrep Pap Test uses fluid to preserve cervical cells. As with the traditional Pap test, cervical cells are collected with a sampling device but instead of smearing the cells on a slide, the device is rinsed into a vial.

"The specimen is then sent to the laboratory where a ThinPrep Processor eliminates obscuring debris and distributes a uniform, representative thin-layer of cells on a microscope slide. The ThinPrep system improves the quality of the specimen, which can result in more accurate diagnoses and fewer, unnecessary repeat tests.

"More than 30 published studies, with over 400,000 patients have shown the ThinPrep Pap Test to be significantly more effective than the conventional smear for the detection of pre-cancerous cervical lesions."

The ThinPrep Pap Test was accepted by the American Food and Drug Administration as a replacement to the previous method of cervical cancer screening in 1996. The FDA agreed the newer test:

Is significantly more effective than the conventional Pap smear for the detection of Low-grade Squamous Intraepithelial (LSIL) and more severe lesions in a variety of patient populations.

Specimen quality significantly improved over that of conventional Pap smear preparation in a variety of patient populations.

"It's not overstating the case to say yes, it is a significant development," said Dr. James of the new smear procedure. "It's a development that has been spreading over the last few years and, given that the technology we have been using is at least 50 years old, it's quite a significant advance."

highly curable if detected early, an estimated one-third of women diagnosed with the disease will die from it; two-thirds undergo invasive treatment to avoid death. Since 1986, the incidence of cervical cancer has been increasing at a rate of three per cent a year.

It's a rise which has been linked to Human Papillomavirus (HPV) ? the most common sexually transmitted virus ? found in 90 per cent of women diagnosed with cervical cancer and which the ThinPrep Pap Test can screen for.

Another factor, asserts Cytyc Corporation, the group responsible for the design, development, marketing and manufacturing of the ThinPrep Pap Test, is a limitation of the traditional smear itself.

"The traditional Pap smear has long been a fixture of preventative health care and has saved countless lives that may otherwise have been lost to cervical cancer," a company spokesperson said.

"However, this 50-year-old method does have limitations that result in false negatives and false positives, allowing for under-treatment and over-treatment."

The term "false negative", the spokesperson added, refers to a Pap smear that is interpreted as normal when, in fact, pre-cancerous or cancerous cells exist.

"The high incidence of false negatives is considered to be a leading cause of late-stage radical treatment to avoid terminal illness. (Our) ThinPrep Pap Test improves upon the traditional method and offers a clear path to the future by providing a better solution for detecting the precursors to cervical cancer.

"A (survey) of 62,000 women reported that 80 per cent had had a Pap smear in the past two years. That number has not changed since 1991 and still the cervical cancer rate continues to grow. Therefore, the next step is to ensure that each of these women who are regularly being screened have equitable access to the most effective Pap test in order to increase the detection of abnormal cells so that they may be diagnosed and treated in a timely manner."

The new process will not only improve analysis capability, but with the results read locally, review is possible as well.

"The implementation of the ThinPrep Pap Test analysis at KEMH means it is now possible to diagnose, retain, and, when necessary, review Pap test results and correlate with biopsies for increased patient care," explained Dr. James.

"The key thing is that all the material will now be available here. We can now look at the whole patient and discuss findings with clinicians as necessary."

was important to note that while the ThinPrep Pap Test was a new methodology for KEMH, the Pathology Department had been using the system for several months for non-gynaecological specimens such as breast lesions, lung, liver and thyroid screening, she added.

"The ThinPrep System using products developed by Cytyc Corporation provides significant improvements over other methods of general cytology screening in a number of ways: it optimises cell preservation and standardises preparation of specimens using a gentle dispersion and transfer process; it simplifies slide screening by offering one single well-preserved slide per case and allowing laboratories to perform additional ancillary testing from one vial.

"Each of these steps provides the laboratory with a clear sample that is easy to read. We take every opportunity to ensure our diagnosis and detection processes are the very best . . . we are pleased to be extending this method to cervical cancer screening."

Despite the benefits offered with ThinPrep Pap testing, regular screening remains an important step in preventing cervical cancer.

"Women should have one every year once they become sexually active although some of the recommendations coming out in the US are that if women have the ThinPrep Pap Test, they can do it less frequently.

"However, that is not the standard of care as of yet. What we like to encourage is that every woman makes sure she takes care of her health and has the appropriate screening test done. I can't stress the importance of that. Prevention, and picking up lesions in the very early stages, is much better than trying to cure an advanced disease."